Postdoctoral Research Associate in the Department of Geography, Durham University

Disclosure statement

Ben Baumberg receives funding from the Economic & Social Research Council (ESRC) and Medical Research Council (MRC), and has received past funding from the Joseph Rowntree Foundation, and the charity Elizabeth Finn Care/turn2us, but is writing in a personal capacity. He is a member of the Labour Party, Compass, and the Fabian Society, but is likewise writing in a non-party political capacity.

Clare Bambra receives funding from Leverhulme Trust, NIHR, MRC, Norface/ESRC. She is a member of the Labour Party.

Many words can be used to describe failing policies – whether it’s a “toxic brand” or the “blunders of government”. Whatever words we use, though, there can be few policies that are more toxic than the Work Capability Assessment (WCA) – the test that determines whether disabled people can claim Employment and Support Allowance.

The WCA has seemingly been criticised by everyone: major charities, doctors and disabled people themselves. The perceptions of it are such that the private sector company carrying out the tests, Atos, reportedly handed money back to the government to escape their contract early because of the damage it was causing their brand and the “very toxic” environment for their staff.

But why is the WCA failing so badly – and what can do we to fix it? As we argue in a new report, we cannot simply put the blame at the door of Atos.

The test, despite its name, simply does not assess people’s capability for work. Instead, it assigns points to people based on a checklist of tasks they struggle with, without considering whether there are any actual jobs that a claimant could do.

Instead of this tick-box approach, the test should measure the extent that someone’s disabilities interfere with their ability to get or keep a job, given who they are (including their age, skills, and experience). Who they are matters – just because Stephen Hawking is working does not mean that other people with the same impairments as him should be considered fit for work. In the real world, your skills, experience and age affect the types of jobs you can do, not just your impairments.

To have an incapacity assessment that actually measures incapacity, we need to take these non-medical factors into account – something that has recently been termed a “real-world assessment”. Practical objections have been raised to this idea: the minister for employment has raised concerns about fairness, while the official reviewer of the WCA felt that there was little evidence of what such a test might look like in practice.

How other countries assess incapacity

To find out if a real-world test is practically possible, we looked at how other countries assess incapacity. We focused on three countries that we know use some form of real-world assessment (Sweden, Denmark and the Netherlands), and four Anglo-Saxon countries that are similar to the UK (US, Canada, Australia and New Zealand).

We found that even the four Anglo-Saxon countries have some “real-world” element to their incapacity tests. As the Canadian system clearly says, non-medical factors such as age and education “directly affect a person’s ability to work”, and therefore need to be considered. It is simply not the case that real-world assessments are utopian and unworkable.

The most promising version of delivering a real-world test seems to be the standardised assessments used in the Netherlands and US. Databases of the various requirements of different occupations are matched against the specific abilities of the claimant, to produce a list of occupations that they can realistically undertake. This potentially gives claimants a clear message about why they are being found fit for work.

The other crucial element is maintaining a dividing line between incapacity and unemployment. There are several reasons that nearly all countries separate incapacity benefits from unemployment benefits: there is less conditionality – if any at all; they provide more money, given the extra costs of disability and politically they are more widely supported. But if we introduce non-medical factors into incapacity tests, this line potentially becomes blurred and, in times of recession, people could become reclassified as incapacitated.

To keep this line clear, many countries have emphasised that incapacity still needs to be traced back to underlying medical conditions. Furthermore, countries including the US, Canada and the Netherlands look at which jobs a person could realistically carry out, given their personal characteristics – but explicitly say they do _not _look at whether are vacancies for these jobs at the present time.

Towards a real-world test

A starting point for turning the UK’s current WCA into a system that actually assesses incapacity would be to replace it with a real-world test. Whoever forms a government in May 2015 should commit to this and quickly set up an expert panel with adequate time and resources to turn this into a reality.

The new system should make sure that those who are not eligible for incapacity benefits are also treated fairly. Unemployment benefits need to be a safe place for disabled people – they should not face the Kafka-esque situation of being not disabled enough for incapacity benefits, but too disabled to meet the requirements of Jobseeker’s Allowance. And clearly the whole process, from the outset, should involve people with disabilities.

There is wide agreement that we have pushed the WCA as far as we can in making minor tweaks and changing provider. Major reform is now needed to restore the system to effectiveness and legitimacy – and this should be based on a real-world idea of incapacity. This is simply because this is what incapacity is, what most people understand it to be and what disabled people need to deal with in the real world.